Purpose To evaluate the effectiveness of an ab interno subconjunctival gelatin implant as primary surgical intervention in reducing intraocular pressure (IOP) and IOP-lowering medication count in medically uncontrolled moderate primary openangle glaucoma (POAG). Methods In this prospective, non-randomized, open-label, multicenter, 2-year study, eyes with medicated baseline IOP 18-33 mmHg on 1-4 topical medications were implanted with (phaco + implant) or without (implant alone) phacoemulsification. Changes in mean IOP and medication count at months 12 (primary outcomes) and 24, clinical success rate (eyes [%] achieving ≥ 20% IOP reduction from baseline on the same or fewer medications without glaucoma-related secondary surgical intervention), intraoperative complications, and postoperative adverse events were assessed. Results The modified intent-to-treat population included 202 eyes (of 218 implanted). Changes (standard deviation) in mean IOP and medication count from baseline were − 6.5 (5.3) mmHg and − 1.7 (1.3) at month 12 and − 6.2 (4.9) mmHg and − 1.5 (1.4) at month 24, respectively (all P < 0.001). Mean medicated baseline IOP was reduced from 21.4 (3.6) to 14.9 (4.5) mmHg at 12 months and 15.2 (4.2) mmHg at 24 months, with similar results in both treatment groups. The clinical success rate was 67.6% at 12 months and 65.8% at 24 months. Overall, 51.1 (12 months) and 44.7% (24 months) of eyes were medication-free. The implant safety profile compared favorably with that published for trabeculectomy and tube shunts. Conclusions The gelatin implant effectively reduced IOP and medication needs over 2 years in POAG uncontrolled medically, with an acceptable safety profile. ClinicalTrials.gov registration number: NCT02006693 (registered in the USA).

No abstract

CyPass Micro-Stent implantation, in combination with cataract surgery, was associated with minimal complications while substantially lowering IOP and/or use of IOP-lowering medications.

No abstract

No abstract

Placement of a supraciliary microstent provides up to 24 months of effective IOP lowering for medication-refractory POAG patients while, on average, decreasing the requirement for ocular hypotensive medications.

Previous reports have indicated that some authors will not recommend surgical decompressions if a loss of sight or no light perception occurs directly after an accident. This situation was seen in seven of our patients. The visual acuity of four patients remained no light perception in spite of surgical treatment. In three other patients, an increase in visual acuity from amaurosis improved to 1/35, 4/20 and 8/20, respectively, following early decompression combined with steroids. This experience together with the positive results of other studies supports carrying out decompressions of the optic nerve, even when an amaurosis occurs directly after trauma.

The influence of corneal thickness on the precision of Goldman applanation tonometry is highly disputed. Goldmann and Schmidt assumed that the physiological variation of corneal thickness does not influence the measurement. But they indicated that an "abnormal" deviation of corneal thickness can lead to a false measurement. In the last 30 years many investigations have reliably demonstrated that thick corneas produce elevated applanation values and thin corneas lower values. The correction value is 1 mm Hg per 25 microm change in corneal thickness. The accuracy of intraocular pressure measurement is important for the detection and monitoring of glaucoma. Therefore it is necessary to recalculate applanation values based on corneal thickness in every patient, especially after refractive surgery. It is also necessary to keep in mind that with applanation tonometry we measure a force. From the force readings we deduce the value of the intraocular pressure. This conclusion is only correct if the theory of Goldmann applanation tonometry is right. But between force measurement and intraocular pressure there is the individual cornea with special properties like thickness, rigidity and astigmatism which can influence the correctness of the measurement. So we can understand why knowledge of corneal thickness can improve the deduction from force measurement of intraocular pressure. It is also reasonable that other individual corneal properties we do not measure or do not know so far can influence the deduction. This means that the corneal thickness is not the only variable. Pachymetry allows us to estimate the intraocular pressure with higher precision. Therefore it should be clinically used.